What Dental Procedures Are Covered by Medical Insurance

Medical insurance can be a lifesaver when it comes to paying for dental procedures, but it's essential to know what's covered and what's not. Many people assume that their medical insurance will cover all dental expenses, but that's not always the case.

Some dental procedures are considered medically necessary and are therefore covered by medical insurance. For example, dental procedures like extractions, root canals, and crowns are often covered when they're necessary to treat a medical condition. This is because these procedures are considered essential to maintaining overall health.

However, routine dental care like cleanings and fillings are typically not covered by medical insurance. These procedures are considered preventive care and are usually covered by dental insurance instead. It's worth noting that some medical insurance plans may offer additional coverage for routine dental care, so it's always a good idea to check your policy.

Medi-Cal covers many dental services at little to no cost to you. You can get dental care at any Medi-Cal dentist in California.

To find a Medi-Cal dentist near you, head to www.smilecalifornia.org or call 1-800-322-6384. This will help you set up your visit and get the care you need.

Medi-Cal Dental coverage includes a wide range of services, such as diagnostic and preventive dental hygiene, emergency services, tooth extractions, fillings, and more.

Here are some of the specific services covered by Medi-Cal Dental:

If you have any questions or need help finding a dentist, call Medi-Cal Dental at 1-800-322-6384 or visit www.smilecalifornia.org.

Your dental insurance can be overwhelming and confusing. Think about choosing a plan that imposes dollar or service limitations, rather than one that excludes categories of service.

To help you stretch each dental benefit dollar, most plans provide patients and purchasers with special administrative services. You can find out if your plan provides predetermination of costs, annual benefits limitations, peer review for dispute resolution, premium adjustments and re-evaluations, and coordination of benefits.

Here are some specific administrative services to look for in your plan:

Dental insurance can be overwhelming, but choosing a plan that imposes dollar or service limitations can help you receive the care you need. This approach allows you to work with your dentist to develop treatment plans that give you the most and highest quality care.

To stretch each dental benefit dollar, look for plans that provide special administrative services, such as predetermination of costs, annual benefits limitations, peer review for dispute resolution, premium adjustments and re-evaluations, and coordination of benefits.

Predetermination of costs, also known as pre-authorization, pre-treatment review, or pre-treatment estimate, can help you budget for treatment by determining your eligibility, services covered, and required co-payment.

Some plans limit your benefits by number of procedures and/or dollar amount in a given year, which can help contain costs and allow for adequate coverage.

Peer review mechanisms can resolve disputes between third parties, patients, and dentists, eliminating costly court cases and ensuring fairness and individual case consideration.

Regular reviews of premium levels can help optimize your benefit levels and ensure that every dollar you spend is used wisely.

If you're covered under two dental benefits plans, notify the administrator or carrier of your primary plan about your dual coverage status to protect your rights and maximize your entitled benefits.

Here are some common types of dental insurance plans:

Remember, understanding your dental insurance plan is key to getting the care you need and staying within your budget.

A waiting period is a set amount of time before your dental insurance will provide full coverage on certain procedures, and it can vary from plan to plan, anywhere from a few months to more than a year.

Most dental plans don't include waiting periods for routine preventive care like teeth cleanings or exams. For basic procedures like fillings, some plans may have waiting periods from 3 to 6 months. This means you'll have to pay out of pocket for these services during the waiting period.